Depression 2 Flashcards
What is the ICD-10 diagnostic criteria for depression?
LOW MOOD - little day to day variation, unresponsive to circumstances
REDUCED INTEREST AND ENJOYMENT = Anhedonia - lack of pleasure from
previously enjoyed activities
REDUCED ENERGY or INCREASED FATIGUE on minimal exertion = ANERGIA
What is psychomotor retardation/agitation?
Slow, monotonous speech and low pauses
Blunted affect - limited facial expression
Inability to sit still, fidgeting, pacing, hand-wringing
What is the diagnostic criteria for depression?
At least 2 of core symptoms: Depressed/Low mood Loss of interest or enjoyment Anergia 2 of the following: Reduced concentration/attention Reduced self-esteem/self-confidnence Guilt or worthlessness Hopelessness/Pesssimism about the the future Ideas or acts of self-harm/suicide Disturbed sleep Changes in appetite
What is the diagnostic criteria for dysthymia?
Chronically depressed mood for more than 2 years 2 or more of the following: Poor appetite/overeating Insomnia or hypersomnia Low energy or fatigue Low self-esteem Poor concentration Feelings of hopelessness
Which prescribed drugs can cause low mood?
Beta blockers Methyldopa Corticosteroids Oral contraceptive L-dopa Carbamazepine Opiates Antipsychotics Interferons
What is the social management for depression?
Occupational therapist Day hospital Sort out housing, employment, benefits Social skills training Carer assessments and groups Exercise can improve mild depression
When are TCAs used?
Used first line in pregnancy
In insomnia as cause sedation
Toxic in overdose- consider risk of suicide
What are contraindications in TCA?
Recent MI Arrhythmias Severe Liver Disease Mania High Risk of Overdose
What are the contraindications for MAOIs?
Pheochromocytoma
Cerebrovascular disease Hepatic impairment
Mania
When are NaSSas used?
Used in combination with other antidepressants in treatment resistant depression
Useful to reduce anxiety
Contraindicated in mania
What needs to be considered when initiating antidepressant treatment?
Initial improvements can start in the first week of treatment
At least 3-4 weeks (or 12 in elderly) is needed before a treatment is considered as failing
If a partial improvement has occurred in 4 weeks, continue for 2-4 weeks before starting
other treatments
70% respond to first medication
